Patient Immobilization Option for First Responders

Whatcom County, WA – Someone hurt in a car wreck is strapped to a rigid backboard and rushed to the hospital by ambulance or aboard a rescue helicopter – a method that began 50 years ago in which first responders firefighters, paramedics, and others have approached patients with suspected spinal injury.

EMS workers here are among the first in the nation to reject traditional spinal immobilization techniques — a neck brace and backboard — in favor of a device called a vacuum mattress or full-body vacuum splint.

It’s a growing trend in U.S. pre-hospital emergency care as more studies show that vacuum mattresses work better than backboards. Even the traditional cervical collar or neck brace is falling by the wayside as unnecessary.

Backboards are notoriously uncomfortable for patients, and — especially with long transport times to a specialized trauma center — further injury can result.

“It doesn’t do any good, and it’s more likely to cause harm,” said Dr. Marvin Wayne, Whatcom County medical program director and the supervising physician for Whatcom Medic One, which provides paramedic ambulance service countywide.

A vacuum mattress is a thick vinyl or nylon-coated fabric blanket stuffed with small plastic beads like a beanbag chair. An injured person is wrapped in the mattress and air is sucked out with a pump. As the air is sucked out and the device becomes rigid, rescuers mold the mattress to the patient, providing a more comfortable and ultimately safer way to protect a patient — especially someone who might have multiple injuries, such as a broken spine, pelvis, and femur.

Wayne points to clinical research conducted over the past several years, including a 2003 World Health Organization study, that shows some 5 million patients are back-boarded in the U.S. annually, but only 2 to 3 percent actually have spinal injuries.

A five-year Society for Academic Emergency Medicine study published in 1998 compared patients at the University of Malaya (Malaysia) and the University of New Mexico hospitals, finding that the patients in Malaya who were not immobilized fared better neurologically than the U.S. patients who were immobilized.

Dr Wayne says this method has been the standard of care in Europe for 35 years.